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General NPI Number Information
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NPI Number | 1033664727
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Entity Type | Organization
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Legal Business Name | JENNIFER PARK, PSYCHOLOGIST
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Dates
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Enumeration Date | 08/23/2016
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 900 WELCH RD SUITE 400
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City | PALO ALTO
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State | CA
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Zip | 94304-1805
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Country | US
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Telephone | 408-426-5725
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Fax |
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Provider Business Mailing Address
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Address Line | 160 LINFIELD DR
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City | MENLO PARK
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State | CA
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Zip | 94025-3741
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Country | US
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Telephone | 909-973-4463
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JENNIFER M PARK
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Credential | PHD
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Telephone | 408-426-5725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY27972
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License Number State | CA
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